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ATTACHMENT 1 – FEHB PROGRAM

TABLE 1
PLANS LEAVING THE FEHB PROGRAM

Enrollees in these terminating plans must make a positive election into another
FEHB plan during Open Season or they will be enrolled in the GEHA Indemnity
Benefit Plan - Elevate option (Plan Codes 254, 256, 255) (the lowest-cost nationwide
plan option for 2020 as determined by OPM).

State Plan Name 2019 Enrollment General Location


Code

New York MVP Health GA4, GA6, GA5 Albany, Broome, Cayuga, Chenango,
Care MX4, MX6, MX5 Clinton, Columbia, Cortland,
M94, M96, M95 Delaware, Dutchess, Essex,
MF4, MF6, MF5 Franklin, Fulton, Genesee, Greene,
GV4, GV6, GV5 Hamilton, Herkimer, Jefferson,
Lewis, Livingston, Madison, Monroe,
Montgomery, Oneida, Onondaga,
Ontario, Orange, Orleans, Oswego,
Otsego, Putnam, Rensselaer,
Rockland, Saratoga, Schenectady,
Schoharie, Seneca, St. Lawrence,
Steuben, Sullivan, Tioga, Tompkins,
Ulster, Warren, Washington, Wayne,
Westchester, Wyoming and
Yates counties

Pennsylvania Highmark NP1, NP3, NP2 Allegheny, Armstrong, Beaver,


Choice Company Bedford, Blair, Butler, Cambria,
Clarion, Clearfield, Crawford, Elk,
Erie, Fayette, Greene, Huntingdon,
Indiana, Jefferson, Lawrence,
McKean, Mercer, Potter, Somerset,
Venango, Warren, Washington and
Westmoreland counties

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TABLE 2
PLANS REDUCING SERVICE AREAS
WITHOUT TERMINATING ENROLLMENT CODES

Enrollees in the areas being dropped who do not change health plans during Open
Season will only have emergency services where they live and they will have to
travel to their plan’s remaining service area to obtain medical care in order to
receive full benefits from the plan in 2020.

State Plan Name 2019 Area Dropped


Enrollment
Code

Colorado Kaiser Foundation Health 651, 653, 652 Eagle, Garfield, Grand, Routt, and
Plan of Colorado 654, 656, 655 Summit counties
N41, N43, N42
Zip codes: 80423, 80424, 80426,
80435, 80443, 80463, 80497, 80498,
81620, 81631, 81632, 81637, 81645,
81649, 81655, 81657, 81658

Washington Kaiser Permanente L11, L13, L12 San Juan County


Washington Options L14, L16, L15
Federal

Washington Kaiser Foundation Health 541, 543, 542 San Juan County
Plan of Washington 544, 546, 545

TABLE 3
PLAN TERMINATING OPTION AND ENROLLMENT CODES
Enrollees in the plan’s terminating option will be automatically enrolled into the
plan option that is identified in the table below unless they enroll in another plan
during Open Season.

State Plan Name Terminating Terminating Option and Codes for


Options Codes 2020
(end of 2019) (end of 2019)

Utah SelectHealth Plan High SF1, SF3, SF2 Standard - SF4, SF6, SF5

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TABLE 4
PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES

State Plan Name New Option 2020 General Location


Enrollment
Codes

All States Aetna Advantage Advantage Z24, Z26, Z25 Portions of all 50 States
and DC

District of Aetna Open Saver QQ4, QQ6, QQ5 Washington, DC


Columbia Access and Aetna
Saver Plan

District of CareFirst Blue Value Plus B64, B66, B65 Washington, DC


Columbia BlueChoice

Georgia Kaiser Foundation Basic LA1, LA3, LA2 Barrow, Bartow, Bibb,
Health Plan of Bleckley, Bryan, Bulloch,
Georgia, Inc. Butts, Carroll, Chatham,
Chattahoochee, Cherokee,
Clarke, Clayton, Cobb,
Coweta, Crawford, Dawson,
DeKalb, Douglas,
Effingham, Evans, Fayette,
Forsyth, Fulton, Gwinnett,
Hall, Haralson, Harris,
Heard, Henry, Houston,
Jones, Lamar, Laurens,
Liberty, Madison, Marion,
Meriwether, Monroe,
Muscogee, Newton, Oconee,
Oglethorpe, Paulding, Peach,
Pickens, Pike, Pulaski,
Rockdale, Spalding, Twiggs,
and Walton counties

Hawaii HMSA Plan Standard 874, 876, 875 Entire state of Hawaii

Illinois MercyCare Health Standard EY4, EY6, EY5 Boone and Winnebago
Plans counties

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Maryland Aetna Open Saver QQ4, QQ6, QQ5 Entire state of Maryland
Access and Aetna
Saver Plan

Maryland CareFirst Blue Value Plus B64, B66, B65 Entire state of Maryland
BlueChoice

Michigan Priority Health Value Y41, Y43, Y42 Alcona, Allegan, Alpena,
Antrim, Arenac, Barry, Bay,
Benzie, Berrien, Branch,
Calhoun, Cass, Charlevoix,
Cheboygan, Clare, Clinton,
Crawford, Eaton, Emmet,
Genesee, Gladwin, Grand
Traverse, Gratiot, Hillsdale,
Huron, Ingham, Ionia, Iosco,
Isabella, Jackson,
Kalamazoo, Kalkaska, Kent,
Lake, Lapeer, Leelanau,
Livingston, Macomb,
Manistee, Mason, Mecosta,
Midland, Missaukee,
Montcalm, Monroe,
Montmorency, Muskegon,
Newaygo, Oakland, Oceana,
Ogemaw, Osceola, Oscoda,
Otsego, Ottawa, Presque
Isle, Roscommon, Saginaw,
Sanilac, Shiawassee, St.
Clair, St. Joseph, Tuscola,
Van Buren, Washtenaw,
Wayne, and Wexford
counties

New GHI Health Plan HDHP 811, 813, 812 Bergen, Essex, Hudson,
Jersey Middlesex, Monmouth,
Morris, Passaic, Somerset,
Sussex, and Union counties

New Presbyterian Wellness PS1, PS3, PS2 Entire state of New Mexico
Mexico Health Plan

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New York GHI Health Plan HDHP 811, 813, 812 Boroughs of Manhattan,
Brooklyn, Bronx, Queens,
and Staten Island, Nassau,
Suffolk, Rockland,
Westchester Broome,
Cayuga, Chemung,
Columbia, Cortland,
Delaware, Dutchess,
Franklin, Greene, Hamilton,
Herimer, Jefferson, Lewis,
Madison, Oneida,
Onondaga, Orange, Oswego,
Otsego, Putnam, St.
Lawrence, Schuyler,
Steuben, Sullivan, Tioga,
Tompkins, and Ulster
counties

Virginia Aetna Open Saver QQ4, QQ6, QQ5 Arlington, Caroline, Clarke,
Access and Aetna Fairfax, Fauquier, Greene,
Saver Plan King George, Loudoun,
Madison, Orange, Prince
William, Rappahannock,
Spotsylvania, Stafford, and
Westmoreland counties

Cities of Alexandria,
Fairfax, Falls Church,
Fredericksburg, Manassas,
and Manassas Park

Virginia CareFirst Blue Value Plus B64, B66, B65 Cities of Alexandria and
BlueChoice Fairfax; Arlington County;
town of Vienna; Counties of
Fairfax, and Prince William
(east of route 123)

Wisconsin MercyCare Health Standard EY4, EY6, EY5 Green, Jefferson, Rock, and
Plan Walworth counties

TABLE 5
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SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES

State Plan Name Plan Option 2020 Location of Areas


Enrollment
Codes

Colorado Kaiser Foundation High 651, 653, 652 Clear Creek County
Health Plan of Colorado Standard 654, 656, 655 Zip codes: 80436, 80444
Basic N41, N43, N42
Larimer County
Zip code: 82070

Michigan Health Alliance Plan High 521, 523, 522 Lenawee County
(HAP) Standard GY4, GY6, GY5

Ohio Medical Mutual of Ohio Standard YF4, YF6, YF5 Adams, Miami, and
Basic YF1, YF3, YF2 Warren counties

Virginia Kaiser Foundation High E31, E33, E32 Fauquier County Zip
Health Plan of the Mid- Standard E34, E36 ,E35 codes:
Atlantic States, Inc. Basic T71, T73, T72 20115, 20137, 20144,
20117, 20184, 20186,
20187, 20198, 22639,
22642, 22643

TABLE 6
SERVICE AREA EXPANSIONS ADDING
NEW ENROLLMENT CODES

State FEHB Plan Plan 2020 New Location of Areas


Name Option Enrollment Codes

Pennsylvania UPMC Health Plan High YS1, YS3, YS2 Berks, Clinton, Cumberland,
Standard YT4, YT6, YT5 Dauphin, Juniata, Lackawanna,
HDHP YS4, YS6, YS5 Lancaster, Lehigh, Luzerne,
Lycoming, Mifflin, Northampton,
Northumberland, Perry, Schuylkill,
Snyder, Sullivan, Susquehanna,
Tioga, Union, and Wayne counties

TABLE 7
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NEW PLAN ENTERING THE FEHB PROGRAM

State FEHB Plan Plan 2020 New Location of Areas


Name Option Enrollment Codes

All States GEHA Indemnity Elevate Plus 251, 253, 252 Nationwide
Benefit Plan Elevate 254, 256, 255

Alabama UnitedHealthcare High Y81, Y83, Y82 Entire state of Alabama


Insurance Co., Inc.
Choice Primary
Advantage

Alabama UnitedHealthcare High AS1, AS3, AS2 Entire state of Alabama


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Arizona UnitedHealthcare High VD1, VD3, VD2 Maricopa, Mohave, Pima, Pinal, and
Insurance Co., Inc. Yavapai counties
Choice Primary
Advantage

Arizona UnitedHealthcare High WF1, WF3, WF2 Maricopa, Mohave, Pima, Pinal, and
Insurance Co., Inc. Yavapai counties
Choice Plus
Primary
Advantage

Arkansas UnitedHealthcare High Y81, Y83, Y82 Entire state of Arkansas


Insurance Co., Inc.
Choice Primary
Advantage

Arkansas UnitedHealthcare High AS1, AS3, AS2 Entire state of Arkansas


Insurance Co., Inc.
Choice Plus
Primary
Advantage

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District of UnitedHealthcare High Y81, Y83, Y82 Washington, DC
Columbia Insurance Co., Inc.
Choice Primary
Advantage

District of UnitedHealthcare High AS1, AS3, AS2 Washington, DC


Columbia Insurance Co., Inc.
Choice Plus
Primary
Advantage

Florida UnitedHealthcare High Y81, Y83, Y82 Entire state of Florida


Insurance Co., Inc.
Choice Primary
Advantage

Florida UnitedHealthcare High AS1, AS3, AS2 Entire state of Florida


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Georgia UnitedHealthcare High Y81, Y83, Y82 Butts, Carroll, Cherokee, Clayton,
Insurance Co., Inc. Cobb, Coweta, Dawson, DeKalb,
Choice Primary Douglas, Fayette, Forsythe, Fulton,
Advantage Gwinnett, Haralson, Heard, Henry,
Jasper, Morgan, Newton, Paulding,
Putnam, Rockdale, Spaulding, and
Walton counties

Georgia UnitedHealthcare High AS1, AS3, AS2 Butts, Carroll, Cherokee, Clayton,
Insurance, Co., Cobb, Coweta, Dawson, DeKalb,
Inc. Choice Plus Douglas, Fayette, Forsythe, Fulton,
Primary Gwinnett, Haralson, Heard, Henry,
Advantage Jasper, Morgan, Newton, Paulding,
Putnam, Rockdale, Spaulding, and
Walton counties

Illinois UnitedHealthcare High Y81, Y83, Y82 Entire state of Illinois


Insurance Co., Inc.
Choice Primary
Advantage

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Illinois UnitedHealthcare High AS1, AS3, AS2 Entire state of Illinois
Insurance Co., Inc.
Choice Plus
Primary
Advantage

Iowa UnitedHealthcare High Y81, Y83, Y82 Entire state of Iowa


Insurance Co., Inc.
Choice Primary
Advantage

Iowa UnitedHealthcare High AS1, AS3, AS2 Entire state of Iowa


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Kentucky UnitedHealthcare High Y81, Y83, Y82 Entire state of Kentucky


Insurance Co., Inc.
Choice Primary
Advantage

Kentucky UnitedHealthcare High AS1, AS3, AS2 Entire state of Kentucky


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Louisiana UnitedHealthcare High Y81, Y83, Y82 Entire state of Louisiana


Insurance Co., Inc.
Choice Primary
Advantage

Louisiana UnitedHealthcare High AS1, AS3, AS2 Entire state of Louisiana


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Maryland UnitedHealthcare High Y81, Y83, Y82 Entire state of Maryland


Insurance Co., Inc.
Choice Primary
Advantage

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Maryland UnitedHealthcare High AS1, AS3, AS2 Entire state of Maryland
Insurance Co., Inc.
Choice Plus
Primary
Advantage

Mississippi UnitedHealthcare High Y81, Y83, Y82 Entire state of Mississippi


Insurance Co., Inc.
Choice Primary
Advantage

Mississippi UnitedHealthcare High AS1, AS3, AS2 Entire state of Mississippi


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Missouri UnitedHealthcare High Y81, Y83, Y82 Bollinger, Butler, Cape Girardeau,
Insurance Co., Inc. Clark, Clinton, Crawford, Dent,
Choice Primary Dunklin, Franklin, Gasconade,
Advantage Greene, Howell, Iron, Jefferson,
Lewis, Lincoln, Madison, Marion,
Mississippi, Monroe, Montgomery,
New Madrid, Oregon, Pemiscot,
Perry, Phelps, Pike, Ralls, Randolph,
Reynolds, Ripley, Scott, Shannon,
St. Charles, St. Clair, St. Francois,
St. Louis, St. Louis City, Ste.
Genevieve, Stoddard, Texas,
Warren, Washington, Wayne, and
Williamson counties

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Missouri UnitedHealthcare High AS1, AS3, AS2 Bollinger, Butler, Cape Girardeau,
Insurance, Co., Clark, Clinton, Crawford, Dent,
Inc. Choice Plus Dunklin, Franklin, Gasconade,
Primary Greene, Howell, Iron, Jefferson,
Advantage Lewis, Lincoln, Madison, Marion,
Mississippi, Monroe, Montgomery,
New Madrid, Oregon, Pemiscot,
Perry, Phelps, Pike, Ralls, Randolph,
Reynolds, Ripley, Scott, Shannon,
St. Charles, St. Clair, St. Francois,
St. Louis, St. Louis City, Ste.
Genevieve, Stoddard, Texas,
Warren, Washington, Wayne, and
Williamson counties

Nevada UnitedHealthcare High VD1, VD3, VD2 Entire state of Nevada


Insurance Co., Inc.
Choice Primary
Advantage

Nevada UnitedHealthcare High WF1, WF3, WF2 Entire state of Nevada


Insurance Co., Inc.
Choice Plus
Primary
Advantage

New Mexico True Health New High EL1, EL3, EL2 Entire state of New Mexico
Mexico

North Carolina UnitedHealthcare High Y81, Y83, Y82 Entire state of North Carolina
Insurance Co., Inc.
Choice Primary
Advantage

North Carolina UnitedHealthcare High AS1, AS3, AS2 Entire state of North Carolina
Insurance Co., Inc.
Choice Plus
Primary
Advantage

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Pennsylvania UnitedHealthcare High Y81, Y83, Y82 Entire state of Pennsylvania
Insurance Co., Inc.
Choice Primary
Advantage

Pennsylvania UnitedHealthcare High AS1, AS3, AS2 Entire state of Pennsylvania


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Oregon UnitedHealthcare High VD1, VD3, VD2 Entire state of Oregon


Insurance Co., Inc.
Choice Primary
Advantage

Oregon UnitedHealthcare High WF1, WF3, WF2 Entire state of Oregon


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Tennessee UnitedHealthcare High Y81, Y83, Y82 Entire state of Tennessee


Insurance Co., Inc.
Choice Primary
Advantage

Tennessee UnitedHealthcare High AS1, AS3, AS2 Entire state of Tennessee


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Texas UnitedHealthcare High Y81, Y83, Y82 Entire state of Texas


Insurance Co., Inc.
Choice Primary
Advantage

Texas UnitedHealthcare High AS1, AS3, AS2 Entire state of Texas


Insurance Co., Inc.
Choice Plus
Primary
Advantage

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Virginia UnitedHealthcare High Y81, Y83, Y82 Entire state of Virginia
Insurance Co., Inc.
Choice Primary
Advantage

Virginia UnitedHealthcare High AS1, AS3, AS2 Entire state of Virginia


Insurance, Co.,
Inc. Choice Plus
Primary
Advantage

Washington UnitedHealthcare High VD1, VD3, VD2 Entire state of Washington


Insurance Co., Inc.
Choice Primary
Advantage

Washington UnitedHealthcare High WF1, WF3, WF2 Entire state of Washington


Insurance Co., Inc.
Choice Plus
Primary
Advantage

Wisconsin Quartz Health High TF1, TF3, TF2 Adams, Buffalo, Columbia,
Benefit Plans Standard TF4, TF6, TF5 Crawford, Dane, Dodge, Fond du
Corporation Lac, Grant, Green, Green Lake,
Iowa, Jackson, Jefferson, Juneau,
La Crosse, Lafayette, Rock, Sauk,
Trempealeau, Vernon, Walworth,
Waukesha, and Waushara counties

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